GROWTH HORMONE SECRETION IN TYPE1 DIABETES:RELATION TO SOMATIC GROWTH AND DEVELOPMENT OF NEPHROPATHY

Abstract

Background : Type 1Diabetes (DM), the most common endocrine metabolic disorder of children and
adolescents. It is characterized by chronic hyperglycemia is associated with microvascular complications.
Objectives : to study GH / IGF–I axis and its relation to actual growth and glycemic control, as well as its
relation to development of micro vascular complications, with particular stress on diabetic
nephropathy(DN). Study design : This study was carried out on 50 diabetic children and adolescents .
Group , included 20 newly diagnosed Patients & group ,, included 30 long term diabetics .In addition, 20
age – sex matched non diabetic children served as a control group. Study children were subjected to :1-
history taking . 2- thorough physical examination including : a) assessment of nutrition status , b) fundus
examination or detection of retinopathy changes if , present , and neurological examination to detect
peripheral neuropathy . 3- Investigations, including: a) routine investigation ; urine analysis , CBC, liver &
kidney function tests . b) Investigations for glycemic control:fasting blood glucose,determination of
glycated hemoglobin (HbA1c) percent.c) Specific Investigations: 1.Measurement of daily urinary albumin
excretion rate (UAER) to decide if there is microalbuminurea (MA) as an indicator of the presence of DN,
2.measurement of human growth hormone (hGH) in serum 3.measurement of plasma & urine IGF-I.
Results :this study found a significantly higher scores of the 3 emotional distress indices among diabetics
more than that in non diabetics . in addition , there were significant differences between the 2 groups in
some social aspects. Both diabetic and control subjects showed similar growth characteristics , recurrent
infection, diabetic ketoacidosis and 2ndry enuresis , as well as oral and perianal moniliasis represented the
most common symptoms of new diabetics . the overall rates of MA, neuropathy and retinopathy accounted
for 18%, 14% & 12% respectively. Both serum GH & Urinary IGF-I were significantly higher in MA
positive diabetics than that in MA negative diabetics . BMI, pubertal duration and HbA1c were
significantly higher in diabetics positive for MA (MA+ve) than that in diabetics negative for MA (MA-ve).
Conclusion : the present work, which reflect mean GH and IGF-I production, strengthen the evidence of an
association between GH and MA and also implicate urinary IGF-I in MA.